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SESSIONS AND WORKSHOPS

SESSIONS AND WORKSHOPS


19

SESSION A

Cancer Control: “Planning and Monitoring” Population-Based Systems: Europe and the World.

Chairs: Dr. Joe Harford (USA), Dr. Paul Ndom (Cameroon), Prof. Michel P. Coleman (UK), Dr. A. Nandakumar (India), Dr. Brenda

Edwards (USA), Dr. Riccardo Capocaccia (Italy)

The session discussed in the context of high, middle and low

income settings (a) how the ‘population tumour burden’ is

measured and monitored (b) how the need for interventions

and services is linked to the capacity to respond © how

cancer plans and programs are monitored to assess

performance (d) how current and future needs for cancer

control services are determined (e) how to address

improving cancer control. in the context of available planning

information (e.g., census, registries, surveillance, projection) and

in the absence of good planning information – what can be

done; how to best move forward (f) what is the nature and role

of collaboration and support from high income and/or more

‘developed’ countriesl

WORKSHOP 1 - Cancer Surveillance: Why is it important, and How Should it be done

LEAD: Dr. A. Nandakumar [India]

The workshop addressed the issue of cancer surveillance – the continuous recording of robust, populationbased

information on the cancer burden. Cancer surveillance is required both to enable the development of

appropriate policy responses, and to evaluate whether those policies have been effective. During this

workshop some reflections came out: the most appropriate measures of cancer surveillance are incidence,

standardized rates, mortality, survival and prevalence data. Measures should be the same the same in all countries as far as

possible for inter-country comparison, in fact within a country the cancer burden varies by age, sex, socio-economic status,

geography. Population-based cancer registries exist in low and middle income countries but more is needed to improve the system:

cancer registries need a well trained and dedicated leader, training and teaming up coordination and collaboration at national

and international level is needed. Also, funds and political support and commitments would make data available to all of the

stakeholders.

WORKSHOP 2 - Cancer Service: Defining Needs, Setting Standards, Evaluating Quality and Safety

LEAD: Dr. Paul Ndom [Cameroon]

The workshop focused on assessment of local needs for cancer services and evaluation of the quality of such

services. The results which came out from the table discussion of this workshop were related to the lack of good

activity in screening, of getting early diagnosis, an higher research level, diffusion of information. In some

places (eg Nicaragua ) the services are limited and patients need to be assessed. Health service is covered in

other places but not the transportation to care, in fact services need to be responsive to the needs of people and the effective

health care system needs to be implemented. Also, the problem of financial barriers and costs of transport and unemployment has

to be considered. Creating a collaboration between NGO and Governement in one hand and between differents NGO in the

other hand is necessary as well as to establish evidence-based national guidelines for screening and prevention.”

WORKSHOP 3 - Cancer Control: Managing Scarce human Resources, Training and Migration

LEAD: Dr. Joe Hardford [USA]

The workshop held by Dr. Harford focused on the issues of building human capacity for cancer control based on

local needs. Important issues came out from the table discussions: There is no cancer control programs in places

like Jordan, Tanzania and South Africa, lack of political will, human and physical capital. Because of the

growing burden of cancer more focus on oncology and under graduation and post graduation levels is

necessary, as well as constant updating to assure people in every region to have current data, focus on prevention and training in

oncology with focus on physical-social aspects. Also, the role-shifting may play a role in stretching human resources, in fact it has

worked in Tanzania and partly in South Africa (training in planning management skills). Thanks to more united voices, clear

messages on needs of the patients from the diagnosis to death, considering physical, psychological and social aspects, it will be

possible to assure that the training occurs across the cancer continuum from prevention to palliative care.

WORKSHOP 4 - Cancer Plans: Their Rationale and Design and Evaluation of their Performance

LEAD: Dr. Heather Bryant [Canada]

“This workshop explored how evidence can be used as the basis for cancer planning. The critical importance of

registries was recognized, and it was acknowledged that use of the data was critical to providing baseline

information. Where these do not exist, efforts should be made to establish them. At the same time, use should

be made of hospital-based or local registries to start the reporting process and to demonstrate the potential

use of the information. The presentations and discussions all noted the necessary balance that needs to be struck between process

and outcome measures, and between short-term and long-term indicators. It is also critical to ensure that the measures are relevant

to the level at which they are measured. In all efforts, the use of benchmarks and national or international comparisons can be used

to motivate policy-makers to use the data for positive change. More sophisticated use of the data includes using it as raw material

for business case development, or to use cost-effectiveness data (perhaps developed with an international pool of experts) to

engage system leaders. [....]


20

SESSION A

[...] It was noted that engagement of policymakers at all stages of the process is critical in ensuring the relevance and acceptability

of the plans and reports. Several tools, including the WHO/IAEA, UICC, and PLANET tools, were identified as possible resources.

However, in using any of these tools, the leadership of individuals trusted to present evidence-based and practical ideas is critical

to success. The final recurring point of all discussion tables was the need to ensure that the whole cancer continuum, including

prevention and palliation, as well as diagnosis and treatment, is represented. In fact, in the areas of primary prevention and

palliative care, consideration should be given to working with a broad range of chronic disease partners to ensure engagement,

and to develop high-impact goals.”

WORKSHOP 5 - Palliative Care: Planing Treatment for Pain, Ensuring Dignity at the and of Life

LEAD: Dr. Xavier Gomez-Batiste [WHO]

This workshop set forth the pressing need for palliative care especially in developing countries where late stage

of diagnosis is all too common.


21

SESSION B

Cancer Control: Europe and the World: International “Collaborative interest Group Workshop”.

Chairs: Dr. Andrea Micheli (Italy), Dr. Andreas Ullrich (WHO), Dr. Luiz Antonio Santini (Brazil), Dr. Luzia Travado (Portugal), Dr. Agis

Tsouros (WHO), Dr. Faith Mwangi Powell (Uganda)

This session has been created on the basis of feedback from

the two previous congresses to provide a forum that offers

an opportunity for participants with common interests to

pursue collaboration and further development of shared

initiatives, whether existing or established de novo at the

3rd International Cancer Control Congress (ICCC). It is

intended that interest groups foster interdisciplinary

participation and engage with governments, NGOs,

foundations, health providers and the public sector.

The session had two themes – to promote ongoing geographic

collaboration and to provide a forum to generate interest on

topics of broad interest or requiring focus that might benefit

from collaboration.

WORKSHOP 1 - Cancer Control: International Collaboration Between the EU and the AU

LEADS: Dr. Andrea Micheli [Italy]

This workshop discussed and explored cancer control statements that should be included in the politicians'

agenda for health collaboration between the European Union and African Union. There was a representation

of different types of collaborations such as: a) collaboration between two organizations or b) collaborations

between several countries from different regions. Having palliative care and psychosocial care, training/

education on primary prevention, cancer registration and cancer research as the main domains to be considered under the EU-AU

collaborations were discussed. The summary of the discussion was about two main priorities. 1) access to treatment and 2)

awareness: early detection. Access to treatment can improve diagnosis and treatment, and improves outcomes.

It was appointed that the ways through which cancer control can be included in the political agenda of the EU-AU collaboration

could be summarised in: Interaction with WHO, UNAIDS, PEPFAR and other efforts; Interaction with Ministers of Health trying to

constitute a lobby with them; submission of the results of ICCC3 to the EU; promotion of an anti-tobacco legislation; raise fundings

for HPV vaccine and stress the importance of screening (eg. treatment availability for early diagnosis, call for populations based

cancer registry). At the moment some on-going collaborations between EU and AU countries were discussed such as the PRISMA

project for palliative care although the EU funded is going well but the African component is small; the APCA and EAPC (European

association for palliative care) collaboration and the palliative care collaborations like the one in South African with some foreign

aid agencies (linked with Uganda and Zimbawe). Informal collaborations do exist but they are not well promoted and thus the

society is not fully aware.

WORKSHOP 2 - Cancer Control: International Collaboration 'Latin American – Caribbean Alliance

LEAD: Dr. Luiz Antonio Santini [Brazil]

This workshop sought to update participants on the progress of Latin American-Caribbean intra-regional

collaboration, and bilateral and multi-national cooperation to promote cancer control in Latin American and

Caribbean countries. Since November 2007 representatives from Alliance country members have

participated in the following initiatives: 1) revitalizing an Ibero-American Network for Tobacco Control

(RIACT) which seeks to share results during ministerial meetings and work forums, and publishes a web-based bulletin; 2) the

establishment of a Latin American Tumor Tissue Repository Network; and 3) the participation by several Latin American countries in

a multicenter clinical research trial organized by the Office of Latin American Cancer Program Development (OLACPD) of the U.S.

National Cancer Institute (NCI). During the interval between ICCC2 and ICCC3, Brazil and Canada signed a memorandum of

understanding for cooperation in the health care sector. Brazil's National Cancer Institute (INCA) is carrying out a program of

bilateral cooperation with the federal Public Health Agency of Canada (PHAC) and with the British Columbia Cancer Agency

(BCCA), a provincial cancer agency. The main challenges to greater collaboration were the lack of financial support to sustain

regular contacts among partners. There is consensus that greater involvement of international organizations like the WHO and

PAHO could help foster the continuity of international collaboration projects.

WORKSHOP 3 - Cancer Control: International Collaboration Between European Union (EU) – Countries of

the Middle East/Eastern Mediterranean Region (EMR)

LEADS: Dr. Luigi Bisanti [Italy]

The workshop intended to explore and leverage opportunities of cooperation and research within the Eastern

Mediterranean Region (EMR) and between the EMR and institutions in other parts of the world. Specific focus

was on a) Cancer control and surveillance: implementation of cancer registries, b) Early diagnosis and cancer

screening, c) Tobacco epidemics. Cancer registration is useful for cancer prevention and control but depends on the completeness

and high quality of the health information system, on skillfulness of devoted operators and on the availability of hw and sw

facilities. Collaboration should focus on raising awareness of usefulness of cancer registry in ministries of health by showing how

helpful for is data analysis for policy making and planning. One of the aims of collaboration should be raising cancer registry high

in the agenda of ministries. Service cancer screening has proved to be effective for cancer control in rich countries. [...]


22

SESSION B

[...] Nevertheless dissemination of this reliable public health tool in low-income countries is undermined by several obstacles and

people at the workshop indicated the main ones as language and culture.Visits from UICC and other prestigious institutions can

help raising priorities for screening of policy makers. International collaboration can help to support structural plans with countries

Health Ministries to apply country adjusted process based on the structure of Health System. Contrasting tobacco epidemics is

crucial for cancer control. Long lasting experiences in high income countries both for preventing and fighting tobacco addiction

provided inconclusive or weak evidence of durable results. It is reasonable that different social and cultural characteristics of lowincome

countries may favor more effective actions against tobacco. Approaches should be multi-sectoral and multi-level involving

also legislation, use of testimonials, tobacco price policies, ban of publicity, etc. It is vital to ensure that the community receives the

education necessary to change norms, which makes the laws then enforceable.

WORKSHOP 4 - Cancer Control for Youth (AYA: Adolescents and Young Adults)

LEADS: Dr. Gemma Gatta [Italy]

The aim of the workshop was to reach an agreement for International collaborative studies on adolescents and

young adults (AYA). Specific focus will be on (a) description of trends in the incidence and survival of AYA

cancers (b) interpretation of possible differences in cancer survival in AYA and suggestions for concrete

solutions for disparities in access to treatment. The hope is that through this workshop, interest groups will foster

inter-disciplinary participation and engage across government/ NGO / provider / foundations / public sectors. Five contributions

(3 oral and 2 posters) on care, incidence and survival supported the discussion. The participants were from Gambia, Iran, Jordan,

America and Europe. The groups agreed about the relevance to: 1) improve the descriptive epidemiologic studies on AYA.

Population-based cancer registries are the first step for developing more detailed studies. The knowledge about risk factors is

limited; however effective preventive strategies should be promoted, 2) understand where AYA are treated and improve

collaboration between pediatric and adult oncologists; to understand what kind of approach is working for AYA; increase

awareness of adult oncologists on AYA cancers and issues, 3) transfer information available into relations to prevent long term

morbidity related to treatment. Need to determine effective follow-up guidelines. Study to improve quality of life in multiple

domains and countries.

WORKSHOP 5 - Cancer Control: The World Cancer Declaration

LEAD: Prof. Franco Cavalli [Switzerland]

With a contribution from ESO (European School of Oncology) and the collaboration of UICC (International

Union against Cancer). The workshop provided context on the background and history of the World Cancer

Declaration (WCD) of 2008 and explored the WCD in terms of what is new and what is important. From the

roundtable discussion came out that in Israel WCD was important and useful as a guideline for measuring

progress, in Slovakia it has been used as a platform; in Canada it was useful as a “marketing messaging”, it planned actions with

national health concern care system (services, quality). Some proposals for using the WCD as a tool for promoting international

collaboration in cancer control were about possible connections with international G20 summit to get focus on health, including

cancer based on “economics of cancer care” to motivate international focus. The rise in cancer among low and medium resources

countries may gain attention. The WCD focus on tobacco control is the best connection between increasing burden globally and the

economic/health intersection among world leaders and national priorities. Main point is to find a “new message”, especially one

that resonates with the advocacy community.

WORKSHOP 6 - Cancer Control: International Collaboration on CPGS (Clinical Practice Guidelines)

LEAD: Dr. Susan O'Reilly [Canada]

The workshop explores the evidence-based rationale encouraging use of clinical practice guidelines. It

intended to promote international networks and collaborations to develop standardized “quality” guidelines

that are adaptable and practically useful to the “country of use”. From the table discussion the main challenges

to the use of CPG's were about the variation between countries that should be reduced, in some countries in fact

there are different provinces with different health systems that cannot have guidelines, so they cannot assure how to promote

involvement in clinical trials. The international community like ESMO or others could be of assistance to the countries with the

development and use of guidelines. Also, one guideline in one country could be useful to others, it could be adapted with

involvement of users. Key challenge for the global community of practice is providing models, advice, tools for implementation for

adapting guidelines for a particular country setting local groups that currently exist to promulgate/support collaborations. There

was unanimous agreement on need for a network of organizations that includes involved in guidelines development, adaptation of

implementation audit and agreement that Guidelines International Groups might be an appropriate “host” for these functions.


23

SESSION C

Cancer Control: Establishing Effective Primary Prevention and Population-Based Screening Programs

Chairs: Ms. Silvana Luciani (USA), Ms. Lianne Vardy (Canada), Dr. Annie J. Sasco (France), Dr. Eugenio Paci (Italy), Prof. Isaac

Adewole (Nigeria), Dr. Franco Berrino (Italy)

This session examined evidence-based pragmatic and

contextual approaches to the development of effective

prevention and early detection programs in the context of

high, middle and low resource settings.

The emphasis will be on reviewing current scientific

evidence and successful programmatic interventions for

cancer prevention and risk factor reduction, both individual

and population based interventions, as well as screening and

early detection for cervix and breast cancers.

Links with prevention of other diseases, promotion of

population well-being, and other public health initiatives, will

be noted where these are relevant.

WORKSHOP 1 - Food, Nutrition, Physical Activity and Cancer Prevention: Policy Implications of the 2007

and 2009 World Cancer Research Fund/ American Institute for Cancer Research Reports

LEAD: Ms. Lianne Vardy [Canada]

The workshop explored the relationships between diet, physical activity and cancer risk. The common ideas

coming from the roundtable discussion were that diet and physical activity should be treated as a priority in all

countries' fight against cancer, in parallel with tobacco control. People should be informed by education,

regulatory framework, legislative changes and dialogue with communities. Some initiatives have been taken to

promote a healthy life style by promoting healthy diet in schools, by influencing industry food companies and by asking

government to subsidize fruits and vegetables. Initiatives for healthy life style must have greater prominence in the political

agenda. Strategic and effective avenues or mediums need to be used to educate the population about the advantages and

disadvantages of lifestyle choices (dietary and physical activity, promote pedestrian friendly cities, work with local councils to

promote facilities for sport and recreation and promote initiatives where people could prepare them own food under the

instruction of a nutritionist. The workshop explored how best to prevent cancer and encourage the policies and actions

recommended by the 2007 and 2009 Worls Cancer Research Fund/American Institute for Cancer Research reports.

WORKSHOP 2 - HPV Vaccines for Cervical Cancer Prevention In Middle and Low Income Countries

LEADS: Ms. Silvana Luciani [USA]

The challenges for wide-spread introduction of HPV vaccines are mainly economic, due to the current high cost

of the vaccine, and issues around financing its sustainable introduction versus making greater investments in

screening. In addition, cultural barriers were identified as a challenge and seen to require public education

and advocacy to overcome. There were several suggestions on best approaches to educate the public about

HPV vaccines and cervical cancer, including the use of high profile 'entertainment groups' and public figures, using the African

diasporas to influence the African countries, influencing politicians, etc. In the end it was agreed that the socio- economic-political

situations are so variable that there is no one recommendation or approach which can be used for advocacy and education. A

final challenge was identified as the delivery logistics, how to monitor vaccine implementation and impact. With regards to the

adaptations required to screening programs, following HPV vaccine introduction, participants felt that it was too early to make

any conclusions. As well, many participants expressed that very little screening programs are actually in operation in most of the

high incidence countries; therefore the first and immediate requirement would be to establish an organized screening program

and educate women to be screened. There was overall consensus, however, that in future screening programs would likely need to

include HPV testing as a way to measure the impact of vaccines. There were some questions of ownership and who's responsibility it

would be to modify screening with vaccine introduction, since cervical cancer prevention involves several program areas (ie cancer

program, immunization program, adolescent health program). Financial and logistical support was identified as the most

important type of support required by developing countries to assist HPV vaccine introduction. In addition, participants expressed

a need from international organizations and scientific bodies to help advocate for and raise the political will and investments for

cervical cancer prevention in public health programs. In conclusion, while participants were supportive of introducing HPV vaccines

and new screening technologies into country programs, many felt that it was not yet affordable and feasible in developing country

situations.

WORKSHOP 3 - Environmental and Occupational Issues in Cancer Prevention

LEADS: Dr. Franco Berrino [Italy]

This workshop explored the scientific evidence on cancer risks associated with exposure to environmental and

occupational carcinogenesis; effective strategies which can be applied to eliminate, prevent and control

exposure to these carcinogens; and the multi-sector approach required for policy development across the

environmental, health and labour sectors. Participants discussed which environmental and occupational

carcinogens pose the greatest risk in their countries and what can be done to reduce risks at the population and individual level.

Carcinogenesis like asbestos pesticides, food items, cotton workers may pose a high risk for cancer in the general population as

well as industrial pollution, electromagnetism, high level EMF. There is a need to raise public awareness about cancer risks

associated with environmental and occupational carcinogens and Media, public awareness campaigns, government policy change

may help to rise the public awareness.


24

SESSION C

WORKSHOP 4 - The Good and The Bad: Lessons From Screening Programs in Developed Countries and

What Other Countries Can Learn From the Experiences

LEAD: Dr. Eugenio Paci [Italy]

The workshop explored evidence based approaches to screening and early detection programs, ranging

from a Western approach which is highly technological to a less technology based approach used in other

countries.

WORKSHOP 5 - Case Study: Breast Cancer Early Detection Guidelines and Experiences In Middle and

Low Income Countries

LEAD: Ms. Silvana Luciani [USA]

This workshop explored the recommendations, guidelines and experiences of middle and low income

countries in addressing breast cancer screening and early detection.

WORKSHOP 6 - Case Study: Tobacco Control

LEAD: Dr. Tania Calvacante [Brazil]

This workshop explored the strategies that have been found to be successful in reducing tobacco exposure at

the population level, particularly in lower income countries; how tobacco control programs can be effectively

implemented; the components that should be included in a multisectoral approach and the necessary

partners; and the challenges to implementing tobacco control programs in lower income countries.


25

SESSION D

Comprehensive Cancer Control: Research and Development: Knowing What We Do and Doing What We Know.

Chairs: Dr. Jon Kerner (Canada), Dr. R. Sankaranarayanan (France), Dr. Marco Pierotti (Italy), Dr. Daniel Campos (Argentina), Dr.

Enrico Garaci (Italy)

This session focused on building capacity to integrate

research that is appropriate to the culture and context of

the population, with a particular emphasis on the

application of research related to cancer control

interventions that have the capacity to influence outcomes.

The session will include a few presentations that would

compare and contrast oppor tunistic versus

contextuallybased participatory action research models for

population-based and clinical research across the cancer

control continuum.

WORKSHOP 1 - Tumor Tissue Bio-Repositories

LEAD: Dr.ssa Maria Grazie Daidone [Italy]

The workshop covered themes regarding collaboration between biobanks collecting and storing human

specimens (tissues, fine needle aspirates, blood/plasma/serum, urine, saliva, stool, etc.), even of limited,

harmonization of approaches through the use of commonly accepted standard operating procedures (SOPs)

agreement on medical information, management and technology, impact of privacy laws in different countries

and impact of biobanks on cancer control in low and middle income countries. In fact human biosamples represent extraordinary

resources to bridge the gap between laboratory research and clinical applications for individual patients. It does this by enabling

researchers to study the bio-molecular characteristics of cancer cells and to link them with what is known about the clinical

behaviour of the cancer. Specifically, human biosamples can be used to investigate molecular pathways and alterations

responsible for tumor development and progression, to identify and test new ways to screen specific types of cancer, to develop

and challenge new drugs, and to identify subsets of patients likely to respond to new drugs or to experience side effects from

therapy.

WORKSHOP 2 - Clinical Trials

LEAD: Dr. Daniel Campos [Argentina]

Independent Clinical Research in cancer faces is an unfavorable scenario: referring to the Academic or Public

Clinical Research, up to the ´80s, huge advances and established the first concepts of modern oncology. For

example, the basics of systemic adjuvant treatment combinations after radical surgery or therapeutic

standards that are still valid and first line options, like current treatments of lymphomas or testicular cancer.

With the development of technology the Registry Studies appeared, sponsored by the Pharmaceutical Industry, with a big leap

forward in terms of patient care and astonishing advances from the `90s onwards. They had clear objectives and efficient

algorithms. But which is the role of governments, independent physicians and nongovernmental organizations when the objective is

the patient and not the registry The burden of the research grows at the expense of the Labs and decreases at the hands of

independent groups, cooperative groups, etc. When we move this discussion out of the Central Countries, like our Latin American

sub continent, special warning signs arise. There are prevalent malignant diseases where very little research is done. A poorly

stimulated professional community with all kind of obstacles in the regulatory, financial and logistic areas definitely erases any

independent clinical research. The scenario for the sponsored clinical research is totally different. Researchers are very stimulated

in academic, training and up to remunerative. In developing countries 95% of the studies are sponsored by the pharmaceutical

industry, which is more than in the developed world. Conclusion: academic, independent investigation should have a much more

important role than the present one, especially in developing countries with differing objectives and positions of industry-oriented

trials.

WORKSHOP 3 - Eurocare Population-Based Cancer Registries, Cancer Survival

LEAD: Dr. Milena Sant [Italy]

The workshop has dealt with the role of population-based survival estimates in reducing inequalities in cancer

outcomes. The roundtable discussion was held by people coming from Romania, Poland, Italy, Spain, Cyprus,

Uk, Slovakia, Slovenia, Gambia, France, Brazil, China, and Japan. In several high income countries (e.g. UK,

France, Denmark) the EUROCARE results have helped in stimulate the national cancer plan, registries need to

provide data on incidence, prevalence, and survival to policy makers and other stakeholders. Data should be

simplified with a language they best understand. In fact Stakeholders and policy providers should be informed on stage of the

disease, tumour characteristics, e.g. biological characteristics, e.g. oestrogen/progesterone, treatment and outcome, diagnostic

procedures and existing collaboration between cancer registries and universities. It will be good to present data which have been

compared with other registries in different regions. The issue of comparability of stage categories should be taken into account

for survival analyses and comparative studies. Cancer registry data can be used to monitor socio-economic or other inequalities

(age, race, sex etc) in cancer risk and cancer survival . Also, the availability of this data can help studying the exposure to

environmental risk factors. The quality of screening programmes are not always good. The EUROCARE survival analyses have

suggested that survival estimates can be biased by different levels of overdiagnosis, in presence of screening programmes.


26

SESSION D

WORKSHOP 4 - Health Services and Health Economics

LEAD: Prof. J.D.F. Habbema [Netherlands]

The workshop discussed the way in which "cancer control packages" should be determined in view of limited

resources in low/middle/high income countries. Are disease burden, cost-effectiveness of interventions and

the wealth of the country decisive in deciding what should be included in the control program The outcome of

the workshop focused on recommendations of how to move the agenda in determining cancer control packges

forward, and what the role of international research, practice and policy collaborations could be. In particular the most critical

steps in moving the agenda of determining cancer control packages forward were: Real equity to be considered in cost benefit

analysis which implies that good basic cancer care for all is to be preferred over advanced care fpr a few. The policy is to be

determined in a dialogue between all stakeholders such as consumers, cancer experts, politicians. Good governance and political

will are essential.

WORKSHOP 5 - Translating Research Into Practice

LEAD: Dr. Jon Kerner [Canada]

In Brazil, only 5% access cancer information. In some cultures, one-on-one communication is more acceptable

albeit more labour intensive. Websites are not the only technologies that are in use. Others include social

networking sites and mobile phones. User centered design is crucial both in-terms of technologies being used

and the cultural appropriateness of the information content being shared. Solutions developed in smaller

countries need a forum for sharing, because not all approaches in the developed world apply in low and middle income countries.

Adaptation of evidence-based approaches to local contexts is critical to uptake. Strategies specifically developed to address the

needs of vulnerable populations may have the broadest applicability, particularly when the vulnerable populations were

partners in the development and implementation of the strategy. Engaging low and middle income countries in participatory KT

research and practice would be helpful to insure that contextual relevance of KT approaches is given a high priority in KT strategy

development. Absent these partnerships, the information and knowledge gaps between the haves and have nots will be

exacerbated, and cancer health disparities will grow larger.

WORKSHOP 6 - Palliative Care

LEAD: Dr. Xavier Gomez-Batiste [WHO]

The workshop explored whether or not research and development is necessary to advance population-based

palliative care and, if so, what research is more meaningful for – subject content advance Health system

performance and integration Optimal clinical practice In resource-challenged environments The forum

intended to explore what mechanisms are best suited to advance palliative care research within and across

national environments; The presentations and discussions all noted the needs of resources for diagnosis and treatments, needs to

identify and quantify needs in multiple domains of health (physical, cognitive, psychosocial, etc) and related resource needs.

Raising awareness of risks among practitioners is necessary, translating evidence to change in policy and practice, increasing

awareness of gaps in knowledge and target research dollars accordingly. Also, resources - financial, human etc- can be enhanced

to build capacity for palliative research by the government support and the funders support to create effective strategies for

follow up care.


27

SESSION E

Cancer Control: “Organization of Population - Based Programs: Europe & The World.”

Chairs: Dr. Renée Otter (Netherlands), Dr. You-Lin Qiao (China), Dr. Fiona Adshead (WHO), Dr. Edward Trapido (USA), Prof. Robert

Burton (Australia), Dr. Massoud Samiei (Austria)

This session examined models for planning and delivery of

populationbased cancer control appropriate to differing

levels of resource commitment.

Discussions will be in the context of (a) what are the

principles and content of population based cancer control

programs (b) how are population based programs

implemented in different resource settings (c) role of

government, NGOs, and other parties in support of models of

interdisciplinary collaboration for successful organization of

cancer control.

WORKSHOP 1 - Supportive and Palliative Care (Priorities)

LEAD: Dr. Xavier Gomez-Batiste [WHO]

This workshop explored the organization of population-based programs in palliative/end-oflife/supportive

care including models providing population-based palliative care within different resource

settings. Discussion ranged from how is palliative/end-of-life/supportive care best integrated within disease

specific programs (e.g. cancer control) as well as in integrated health delivery systems to how can

organizational models for population-based palliative care enable to development of other aspects of cancer control like

prevention, early detection. Important issues came from the table discussion: Private system has established palliative care system

providing support to cancer patient at home in at clinics. However this is centralized and everybody cannot have access and many

countries do not have cancer control programmes Need to ensure p.c. is integrated into cancer centres. In Malaysia no community

services. In different countries (Africa) palliative care is integrated into community/home care services. Integrate pc into common

services that are available. However some countries have got facility based care. In Spain challenge how first care services

promote geriatric palliative care services. Also, palliative/end of life professionals be effectively incorporated into

interdisciplinary cancer/chronic disease management in resource constrained environments by training of professional people, by

involving psycho-oncologists.

WORKSHOP 2 - Pediatric Oncology (Priorities)

LEAD: Dr. Ian Magrath [Belgium]

The workshop integrated participants from INCTR Belgium; Perú, Canada, Brazil, Tanzania, Italy, and Nigeria

and explored pediatric oncology in terms of volume of service to outcomes in different contextual resource

settings and links quality of outcome to defined inputs especially availability and accessibility to both human

and technical capita. The factors that were discussed were the optimal pediatric cancer care outcomes in

resource constrained environments and the steps needed to be taken to improve survival rates. These are linked to access to care,

the early detection on the diagnosis, the importance of training and information regarding cancer prevention and the importance

to have appropriate planning units and cancer centres for children. The effective capacity to manage children with cancer it may

be achieved in remote and resource constrained environments ensuring housing for families at specialized centres, transport

support close to the hospital where treatments must be provided and the capacity building for practitioners working in remote

areas (telemedicine is known to be very succesful). Another issue is the necessity to preserve family integrity and the absolute need

of cancer registration. There were several non-medical factors discussed that influence the management of pediatric oncology

patients, such as the mass media and public education campaigns to aware health care professionals and society in general. The

need for specialized training in all aspects of the diagnosis and management of cancer in children, including palliative care is

fundamental, in resource limited countries.

WORKSHOP 3 - The Organization of Primary Care Systems (Priorities)

LEAD: Dr. David Weller [UK]

This workshop included participants from Finland, India, Canada, Switzerland, Denmark, Portugal, Italy,

Netherlands, Brazil, Check Republic, Scotland, Ireland, Australia, New Zealand, Denmark, and Latvia – hence

a very wide range of health care systems were represented. It explored how primary care can be most

meaningfully engaged in population-based cancer control. Several important roles for primary care were

identified and discussed: primary prevention, focusing on behaviours such as smoking, physical activity and diet, screening to work

in conjunction with public health efforts to promote uptake and informed choice. There was a particular emphasis on the use of lowcost

screening technologies in developing countries, early diagnosis focusing on how primary care can more effectively encourage,

early presentation with symptoms (through patient education and promoting awareness), and to recognise and respond

effectively to these symptoms in order to promote early diagnosis, follow-up and survivorship recognising that primary care has a

growing role internationally in managing cancer patients after their acute phase of treatment, and providing more personalised,

co-ordinated care, palliative care. National cancer strategies should ideally highlight specific roles for primary care, and provide

guidance on how primary care and public health efforts can be better integrated.


28

SESSION E

[...] There was a detailed discussion of the primary care workforce; if it is to provide high quality cancer control services it must

receive appropriate education and training – there also needs to be an appropriate mix of health care providers, in which GPs,

specialist nurses, cancer specialists and other key providers fully integrate their activities. A well-trained primary care workforce

has the potential to provide economical and cost-effective services, particularly in low-income settings. Finally, the workshop

emphasised the importance of good systems of information-sharing between primary and secondary care and the promotion of

shared responsibility and knowledge. In an integrated cancer plan the involvement of primary care is vital, and needs to be well

co-ordinated with other health care providers.

WORKSHOP 4 - The Organization of Diagnostic and Treatment Services (Priorities)

LEAD: Dr. Massoud Samiei [Austria]

The workshop comprised of participants from Brazil, Canada, Cuba, USA, Nicaragua, Vietnam, Sri Lanka,

Estonia and Austria discussed about the cancers that can be treated for cure, life extension or regain of

functionality including roles of therapies for palliation and symptom control. The workshop covered the

organization of diagnostic (pathology and radiology) and treatment services (surgery, RT and chemotherapy)

taking into consideration specific examples from less resourced countries. The participants discussed about how the populationbased

diagnostic (pathology, radiology) and treatment services (surgery, chemo and radiotherapy) are organized in their

countries. In most countries of Latin America there are very few specialists, and only few countries have got true national health

services; in most of the cases there is a combination of private and public services and the private clinics are often well resourced

from a technology perspective. In particular in Brazil's case, the majority of cancer cases go to public system; there is a National

Cancer Institute where they provide early diagnosis, treatment, and palliative care. In Nicaragua, all health services are free

including oncology diagnostic and treatment services but they don't have enough health professionals and only one oncology

centre. In the case of Vietnam the cancer treatment facilities over the country is expanding and they have two comprehensive

cancer centres, in addition to some 14 other operational centres. However, in all developing countries, there is a great shortage of

adequate cancer professionals and infrastructure. The participants agreed that the key challenges to making the model more

effective are: learning from the developed countries (successes/mistakes) providing evidence based care guidelines and building

partnerships alliances, de-centralization of cancer centres according to population needs, social security coverage, research,

appropriate equipment and technology, training of specialists (all areas of oncology); adequacy and access to services and

optimization of resources (cost effective). It is also very important to create effective partnerships that can be built with national

and international agencies to direct and tailor support to meet developing countries needs. The IAEA PACT partnership was

mentioned as a good example already in place to facilitate such collaboration.

WORKSHOP 5 - Organization (Priorities) for Aligning Resource Needs and Capacity (Including Alternate

Care Delivery Models)

LEAD: Dr. Jon Kerner [Canada]

Discussion centered on matching resources to patient needs. For example, there is a disparity between the

need for radiotherapy and available resources in some parts of Latin America. In the U.S. there are large

health service disparities with respect to cancer screening and treatment. Italy and Romania discussed the lack

of resources for cancer patient registration, where as Slovenia stated that had no cancer control program within their country.

Canada focused on the transition from care provided by family practitioners to specialists and back again as being a challenge

they were trying to address. A key challenge mentioned by many countries is the impact of a change in political leadership

changing the priorities within a country towards cancer control. Finally, with respect to integrating cancer control with existing

health services, Gambia described how they were integrating pharmacists into their cancer control program efforts, reflecting how

countries with more limited resource bases may want to consider broadening participation in cancer control beyond the traditional

cancer specialty sectors.


29

SESSION F

Cancer Control: “Critical Factors Influencing the Establishment, Maintenance and Sustainability of Population-

Based Programs”

Chairs: Dr. Edward Trapido (USA), Dr. Massoud Samiei (Austria), Dr. Josep Borras (Spain)

For both developing and developed countries, this session is

intended to examine how, the relevant constituencies of who

must ‘champion’ cancer control must collaborate to create a

coherent case for the maintenance and sustainability of

cancer control activities – either as a disease-specific

approach or a combined approach to combating NCDs.

Explores (a) how do you integrate initiative and efforts

across multiple constituencies addressing components of the

implementation of cancer control and NCD (b) what are the

processes used in different resource settings to achieve

effective drug budgeting, health technology assessment and

health economics, and (c) how do countries support public and

societal engagement - what is the role of civil society.

WORKSHOP 1 - Implementing Leadership Forums to Advance Cancer Control In Latin America

LEADS: Ms. Cynthia Vinson [USA]

The workshop integrated by participants from the United States, Peru, Brazil and Canada and explored the

progress that has been made in Comprehensive Cancer Control planning in Latin American Countries that

participated in Leadership Training co-developed by NCI, ACS & UICC between 2006 and 2008. In order to

maintain and build Comprehensive Cancer Control in Latin America, participants in the workshop noted that

linking NGOs from Tobacco cessation movements to could help cancer focused NGOs. The private sector could also help to

maintain commitment with governments and the use of the media to highlight positive stories on how to save lives, and what are the

alternatives to tobacco. To build and maintain financial support for Comprehensive Cancer Control programmes, it is essential that

each country has to be understood in the context of their own country health system. For example in Peru only 25% of the

population is covered by the social security system so there is a multisector coalition support which is the way to keep

Comprehensive Cancer Control in the forefront of the priorities of the Ministry of Health. This differs in each country. In Peru there

are civil society organizations drawing attention on to the necessity of a Comprehensive Cancer Control Program and they all

agree that reporting and notifying to public and private health sector is the best way to draw attention of the Ministry and the civil

society. The major obstacle to maintain Comprehensive Cancer Control in Peru is that the National Cancer Institute is independent

from the Ministry of Health and there is also an inadequate funding and when the funding is available there is a lack of efficiency

in the program administration. In Brazil Comprehensive Cancer Control is based on health indicators, cancer indicators (5 years

survival by cancer type). Volume of mammograms, cervical cancer screening test (Pap test) and the deceasing percentage of the

population smoking: mammography screening has been increasing and smoking and alcohol has decreased.

WORKSHOP 2 - Patients & Information in The Internet Era: Integrating Patients and Information into

Cancer Control - How to Integrate Efforts into Support for Cancer Prevention and Control

LEAD: Prof. Francesco De Lorenzo [Italy]

The workshop was attended by people coming from high, middle and low income countries, including USA,

Canada, Europe (including Western and Eastern countries), Africa, India, and South America. It was designed

as a hands-on, interactive round table discussion on the information needs of cancer patients, with an intent to

facilitating the exchange of information and sharing of experiences among delegates from organizations with well-established

CIS and those from countries having fewer resources and greater information challenges. The outstanding remark that came out of

this event is that in developing countries, and above all in Africa, people lack basic knowledge on health and diseases. Therefore,

advanced concepts like cancer can only be clarified within the framework of general health promotion and prevention awareness

campaigns. The most successful way to get people 'health-literate' would be to use TV/radio, the most popular media in

developing countries. This would involve spreading the most meaning messages through peak audience-winning shows like soap

operas (scoring the highest audience rates) and cartoons for children (since information must be age-appropriate). In this respect

NGOs and professional organizations can play a major role. Actually the will have to be invited to take part in TV/radio

programs but close monitoring will be required in order to prevent misleading and contrasting messages from being spread.

Another point that everyone agreed upon is that information strategies require considerable resources, for example to design and

set up free-phone CIS's, which can only come from the national governments. In order to do this not only do policy makers have to

be shown how important information is for cancer patients and their families, but also industrialized countries that are helping

developing countries define their respective National Cancer Plans have to consider information as an absolute priority. Of course

good cancer information is impossible if doctors are not involved. At present they do not care for information since they do not

know how to communicate with people who are 'health-illiterate'. Therefore, health information, and more specifically, cancer

information training programs will have to be designed to fill this gap. Doctors will have to learn how to use a simple language,

meaning easy to understand by everyone, and also how to be effective within the time limits of their busy routines; they have to

acquire communication skills that help them express the messages in a customized way based on their patients' age (elderly and

children cannot be addressed the same way), and culture. In this respect, CIS's can provide doctors the best training. Last but not

least the workshop participants stressed the need that the internet be available to everyone: in the internet era there are still

people who cannot access the web. For example, in most African countries only professionals can, and so the internet has no

relevance or benefit for the general population. The latest technology is also most wanted (instant connection). In conclusion, the

lessons learnt from our workshop show that information is a most urgent need in developing countries, but people have to be

educated in health promotion and prevention before they can be in more specific issues like cancer. In this respect the 'information

divide' can be overcome with the help of all international agencies that are at various levels partners with developing countries.


30

SESSION F

WORKSHOP 3 - International Cooperation for Cancer Control: Pact Programme Experiences

LEAD: Dr. Massoud Samiei [Austria]

The workshop comprised of participants from Vietnam, Sri-Lanka, Gambia, Italy, Spain, USA, and Austria

explored how international cooperation can be maintained and expanded using the experiences of the IAEA

PACT Programme (six countries, one in each WHO region, were initially piloted by the PACT Programme). The

PACT Program countries maintained involvement of international organizations in each Pilot Country (e.g., in

Vietnam – WHO / IAEA/ PACT worked together with Health Ministry and organization responsible for palliative care). From the

roundtable discussions the major obstacles faced in maintaining involvement of international groups were the necessity of a closer

follow-up, the lack of capacity for planning, as well as for cancer control fellowship, cancer registry and palliative care training.

The current world financial situation has not really impacted the support for PACT Program because PACT has tried to utilize the

existing capacities and potential in each country and region to plan and implement its priority actions. There are other

International groups that might be approached to support Comprehensive Cancer Control (e.g., in Sri-Lanka WHO and the

American Cancer Society, and in Vietnam the Lance Armstrong Foundation and European Union). The best way to keep the PACT

Program partners working together, despite changes in leadership, governments and disease focus, is the commitment of the local

Health Ministry and the establishment and operationalization of a Steering Committee for Cancer Control. The best way to verify

whether a Comprehensive Cancer Control Programmes is working at national level is by monitoring performance, evaluating

results and conducting follow up missions.

WORKSHOP 4 - Building and Sustaining Political Awareness and Momentum

LEAD: Prof. Murat Tuncer [Turkey]

The workshop integrated by participants from Switzerland, Canada, Philippines, Slovenia, Turkey and South

Africa discussed on how Cancer Care in countries, especially developing countries, depends on political

awareness, political will, and financial commitments. Sustaining these efforts is difficult because of the

changing political, financial, and disease burden priorities, among others.

The workshop also explored how international cooperation can be maintained and expanded by using the experiences of the

PACT Programme. From the roundtable discussions the strategies worked to maintain and increase political momentum were: an

anti-smoking legislation, the seeking of a nation wide policy acceptance, to know the public sensitivity, the importance of the public

voice to push government and the creation of a pool of capacity building for human resources. The major obstacles faced in

maintaining political involvement, both at the national level, and at the local level were about the health professionals who are not

trained to be political involved, the old fashioned medical model, the lack of patient education, the sustainability of government

and the brain drain. Finally the importance of the media is essential to involve the pepole, including cancer patients, and to engage

politicians.

WORKSHOP 5 - Role of Patient and Public Engagement in Comprehensive Cancer Control

LEAD: Ms. Pat Kelly [Canada]

The workshop discussed about the ways to begin and maintain Comprehensive Cancer Control Programs. There

are at least two ways to do it: one way is a “top down” approach, in which governments or international

organizations design, build, fund, and maintain CCC. Another approach is the “bottom up” approach,

beginning with Community Participation, and building grass-roots movements of individuals (e.g., patients). This

workshop also looked at Community Involvement- either by patients, the general public, and non-governmental organizations

(NGOs) in maintaining CCC.


31

SUPPORTING LETTERS

Greetings from Commissioner Vassiliou

to the 3rd International Cancer Control Congress

Honorable Mary Harney

I would like to congratulate you on the organisation of the 3rd International Cancer Control Congress

which offers a valuable opportunity for dialogue and exchange of knowledge and best practice amongst

a wide variety of stakeholders across numerous countries. This excellent initiative has the full support of the

European Commission which shares the ICCC vision of the importance of bringing together a broad range

of relevant actors in order to more efficiently combat cancer and lessen its burden, both for individuals

and for society.

Dear Dr Andrea Micheli,

I would like to thank you for your letter of August 4th regarding the III International Cancer Control Congress that is going to be

held in Cernobbio from the 8th till the 11th of November.

I agree with you about the need of developing international collaborations programs in the fight against cancer field. From now on

you will count with my collaboration to promote and facilitate contacts within the countries of my office competence.

Unfortunately I will not be able to participate to the ICCC3 because in that week I will be in a mission in Indonesia and Malaysia.

I will be very grateful if you could inform me about the results and decisions taken in the congress regarding the collaboration

between countries of the Mediterranean area.

Best regards,

Stefania Craxi

Secretary of State

Italian Ministry of Foreign Affairs


32

SUPPORTING LETTERS

rd

Milan, 3 November 2009

Dear Dr Pierotti,

I sincerely thank you for your invitation to the Third International Cancer Control Congress.

It is an honour for the Lombardy Region to host an event on cancer care, a topic of such strategic importance.

The Regional Government of Lombardy is strongly committed to oncological research, as we are well aware that our support can

really enhance the extraordinary daily efforts made by doctors and researchers.

We know cancer is a challenge, but it is a challenge that can be won, in fact many patients have successfully recovered from it. If in

the 1950s oncology exclusively meant surgery and radiotherapy, in the following half a century things changed so much that the

words by Carlo Emilio Gadda who, in his book “Acquainted with Grief”, in 1938 referred to cancer as the obscure evil, are now a

thing of the past.

With this belief, I wish the best of success to the scientific community gathering at Cernobbio. I hope that during your discussions,

new approaches and policies will emerge and that they will be soon translated into benefits for patients in Italy as well as all over

the world.

With my very best wishes,


33

CERNOBBIO’S DECLARATION

PARLAMENTARY QUESTION’S

rd

Answer given by Mr De Gucht on behalf of the Commission to a question by honorable Iva Zanicchi* on the 3 ICCC results

The Commission is well aware of the burden of cancer in Africa and follows with detail through its dialogue with the World Health

Organisation (WHO) the monitoring on the burden of disease. The last world report on the distribution of burden of disease by

regions and causes indicates that cancer caused in 2009 the lost of some 6 million healthy life years considering its impact on ill

health and premature deaths. This represents 1.5 % of the global burden of disease in Africa.

Taken in a wider scope, the burden of non-communicable diseases is growing in absolute and relative terms in developing

countries. In Africa, such burden represents over 20 %. While non-communicable diseases are not considered as priority targets in

the Millennium Development Goals (MDG), the Commission recognises this growing burden and concern, and has contributed to the

European Union's inputs in the resolution on MDGs which will be discussed at the WHO executive Board in February 2010 in

Geneva. The discussion will follow towards the MDG high level meeting in September 2010 and the European Union will keep in

mind the growing challenge of other health priorities, as non-communicable diseases, including cancer, in its partnership with

developing countries. In the EU Africa strategy, the Commission gives priority attention to communicable diseases and reproductive

health, still the major causes of ill health and burden of disease in the continent. However, the health approach in the Commission's

dialogue and actions with Africa, the emphasis is gradually given to the aligned and predictable support to comprehensive

national health policies and strategies. The EU Africa strategy's Action Plan 2008-11 explicitly mentions the target to

progressively abolish user fees for basic healthcare. The Commission believes that national health plans should define basic

healthcare services, including preventive and curative activities; aimed at universal coverage. Adequate participatory and

evidence-based national health strategies should include services according to priority areas and the efficiency of interventions in

relation to the available or potentially available (related to national and international commitments) budget. The inclusion of

preventive and curative activities to reduce the burden of cancer needs to be decided in this context. The inclusion of hepatitis B

vaccine in the national immunization programmes is already rendering clear results in the reduced incidence of liver cancer. The

prospects of including papiloma virus vaccines to prevent cervical cancer can also have a major potential impact. The Commission

is in active dialogue with the Global Alliance on Vaccines and Immunization in these challenges. Other essential preventive

activities relate to the promotion of health lifestyle behaviours, including compliance with the commitments under the framework

Convention on Tobacco Control; which should constitute essential elements of national health plans. The Commission has at the

moment an open call for proposals to fund innovative strategies to better address the burden of non-communicable diseases. But

its main approach in Africa and also in other regions is through aligned and predictable support which may enable countries

decide the scope of basic health services. The Commission is also very active in the International Health partnership, aimed at

progressively aligning the many donors and global initiatives on different diseases or health challenges, around integrated plans

and budgets. This is connected with the initiative called 'Joint Assessment of National Strategies' which will support countries in

defining comprehensive health plans (including attention to non-communicable diseases - also cancer - much neglected in most

health plans in Africa led by the emphasis on MDGs) and encourage all partners to fund these comprehensive plans.

* member of the delegation to the ACP - EU Joint Parliamentary Assembly

CERNOBBIO DECLARATION ON CANCER CONTROL

Presented and signed at the Third International Cancer Control Congress held in Cernobbio, Como, Italy, 8 – 11

November, 2009.

To the leaders of the European Union and the African Union

We, physicians, cancer patients, volunteers and cancer control stakeholders from governmental and

nongovernmental organizations, assembled at the Third International Cancer Control Congress in Cernobbio,

Como, Italy, 8 – 11 November 2009

call upon you:

to invite the citizens of your countries to share with others their knowledge and experience on cancer control;

to allocate sufficient funds for the development of effective cancer control plans and programmes in your

countries;

to include cancer and other non-communicable diseases on the global, regional and national health and

development agendas

to promote that major stakeholders in health and development agencies include cancer control interventions in

their programmes and activities;

to include cancer in the agenda of collaborations between the European and African Unions following the Addis

Ababa Joint Declaration of 2007.

Name Surname Istitution

E-mail

Phone

Signature

CONCTAT US

Andrea Micheli - Director “Descriptive Study and Health Planning Unit” - Fondazione IRCCS "Istituto Nazionale dei Tumori“ –

Milano (Italy) - e-mail: andrea.micheli@istitutotumori.mi.it – fax: +39 022390 3528 - CERNOBBIO


ENDORSING ORGANIZATION

34


Charming

Useful

Trust

Partnership

Fraternity

Companionship

Humanity

Surprise

Success

Commitment

Solidarity

Elated

Change

Welcoming

Global Linking

Future

Involving

International

Excellent

WWW.CANCERCONTROL2009.COM

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